Healthcare Provider Details

I. General information

NPI: 1609238930
Provider Name (Legal Business Name): AMY PORTACCI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 5TH AVE NE STE 201 WEST
SEATTLE WA
98125-7025
US

IV. Provider business mailing address

10601 5TH AVE NE STE 201 WEST
SEATTLE WA
98125-7025
US

V. Phone/Fax

Practice location:
  • Phone: 206-287-6400
  • Fax: 206-341-1801
Mailing address:
  • Phone: 206-287-6400
  • Fax: 206-341-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60943581
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: